08060167 (2) CITY OF CUPERTINO 'j-
BUILDING DIVISION
BUILDINODIVISION PERMIT �. C,O1�C RAC,T(TR,I DIV TIONv,
1 PERMIT NO.
BUILg��MRBEPALMA LN LINDY ROOFING CO INC 08060167
OWNER'S NAME: _ PER.MTr ISSUE DAM
JEWETT MARGARET M 5554 HARVARD DR 06/24/2008
NE:
SANn'ARY NO. CONTROL NO.
ARCHITECT/FNGINEEA: BUILDING PERMIT INFO
RE-RF RMV EXTNG WDSHK RF& BLDG ELECT PLUMB MECH
l` QO O D O
X00 LICENSED CONACTORS DECLARATION IOb DaSCrI VOA
TII
1 bunchyuron Nn 1 am imaxsed under provisions of Chapter 9(commencing `"---^ ^' - _^!! P
wiN Bennion 70fiU)of Dionlaf me BualmssodProfusions Code.sed myliconseu
+ „ Lt..rattamerc a 21
p viz Liunx Clm LY.N
-FO Oam Comracmr
e uuuy��� ARCHITECTS DECLARATION
e < I understood my plane shall W used u public records
Dy
nor^ Clewed Pmfwianal
3 OWNER-BUILDER DECLARATION
E I hereby Anion that I am exempt from the Contractor's License Law far the,
p O following moon.(Section 713 1.3,Business and Prorestions Code:Any city or county
e S ff which requires a permit to construct,alter. mprow.demolish,or repair any structure
anij prior to its issuance,also requires the applicant for such permit to rate a signed summer
g2< that he is licensed p..artmthe provisions ofNcComomer.licenseLaw(Chip.9 Sq.Ft. Floor Area Valuation
yt-� (commencingwirh Sudon700olof DivuionlofN Busineuand Profcuions Ca' )or
y 3
that Im Is cumin mmefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.3 by am applicant for a permit objccu dse applicon in a civil penalty of APN Number Occupancy Type
wasmt roam an few hundred dollars(3300). P Y YP
I,mo wafdtepropeM.mmyemploymawithwaguasftWwlecompensadon,
will do dawork and meauuctum W nasimended or offered lmsam(Sec.7066,Buhmss
Md Pmrrssin.Cade:The Comersemes Lune Law diva man apply m an owner of Required Inspections
pmpM y who buildsmireprowmoron,andwho doessuch work hiouclfmthrough his
awe employees,provided drat such improvements art not intended oroReml fmsale it.
however,lie building or improvemem ismld within one year of completion,the awnea
builds will haw the Woken of proving Nal he did an,dtiW or improve for purpoe of
ole.).
❑1.ss owner of the property.am exclusively comoctiog with licensed colNlcrom m
constmcs the project(Sec.7014.Business and Pmfesuou Code:)The Commcmes U.
come law diva not apply in an caner of propeny who builds or improves theeon,and
who contracts for such pmjeets wire a mnoxsor(s)licensed pursuant in the Contractor's
Liune law.
❑lameman'tundm See ,B&PCforthismuom
Owns Dam
WORKER'S COMPENSATION DECLARATION
1 hereby of arm under penalty of perjury one of the fallowing dela atioes:
I
haw and will maintain a Certificate of Consent an self-insure for WorriesCompen-
md.n.as provided for by Section 3700 of the Labor Code.for rhe pu ltermnu of the
work for which this permit is issued.
❑1 haw and will maintain Workes Comperuation Insurance,as required by Section
1700 ofine Labor Code,for the perfornmee ofine wort for which this permit W issued. '
My Worker's C/om�p�^elnadon InyYov. ori r and Polity ny�mpyer
Carrier. I n-1 r-U Policy No.: ' '-�2
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
This secdm red not M completed lithe permit Is parent,hundred dollars(3100)
or leo)
I certify that in the performance of dm wart for which this Permit is issued,l shill not
employ my person in any meencrao as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cer iEcam of Exemption.you should
become subject an Ne Workers Compensation provisions of Jar labor Code you mast
.J z forthwith comply with such provisions or this permit mall be dttned revoked.
Z O CONSTRUCTION LENDING AGENCY
[-� Ihereby.111.mu mem uaconswction lending agency for the performanceop
E
dm wet for which this pewit is issued(Sec.3097,Civ.C.)
�W 0 Lemmes Name
z Lattices Address e
U 0 1 certify Nat I have mad this application and sante than the show information is -
emma I agree m comply with all city and county ordinuted and fuse laws misting in
.0 V building construction,and hereby autherim mpmacratives of this city to enter upon tht,
„ashow-mentioned progeny for inspection which s
(We)agree m ow,indemnify tad trop harodeas rot,City of Cupertino against
(q in
equnce of tis,eesttsand of this Permit.
APPLICANT
may in any way¢ere againstsalti City
C_12, A PLICA T of DERSTA gof this Pewit. = �� J n-
^ APPLICANT ULATIONANDS AND WILL COMPLY WITH ALL ryryryON-POWT Issued by: Date _4:;/
SOU REGULATIONS. t - /�x l I
\ ✓L—� �—�- Y!/ 71/(,7
Re-roofs
signet o(ApplimHAZA DOU Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicantor forum buildinge,apart 91 or handle haordons material
as dented by 25 Cupertino Munici 1 Cotte.CTapter 9.12,and the Health a d Safety
Coude, C]Y.cuicm zsslz(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs No '
Will the applicant or future Wilding occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
+it haoNnm W cmtsmirunts u food by the Bay Ara Air Quality Management all new materials for inspection.
D'u rict7
❑Y.
u /
Ibe.matlme has mat5M.255u"255umk:r CluPterd.9safthe Cilifar- �f �/ �� V
nWHolth&remly Cant.ssdmuxalitior,resnd233ility d.nund muifdc building Z
diva rot curmndy haw•umanl Uw it u my responsibility m ropy de attupot of dm
mq{rimmeµs whkh mus Ee met prio-m issuance of a Cmifirale f(l�svpanes
Si of Applicant Date
owmrm;nmerV<dsenl mm All roof coverings to be Class'%;."or better
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36932057 . 00
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT # . . . . . . . . . : BS000005199
REFERENCE ID # . . . : 08060167
SITE ADDRESS . . . . . : 20030 DEPALMA LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . I . . . . .. JEWETT MARGARET M
ADDRESS . . . . . . . . . . : 20030 DE PALMA LN
CITY/STATE/ZIP. . . . : CUPERTINO CA, 95014-3189
RECEIVED FROM . . . . : LINDY ROOFING CO IN
CONTRACTOR . . . . . . . : RUMFORD, LINDY LIC # 3921
COMPANY . . . . . . . . . . : LINDY ROOFING CO INC
ADDRESS . . . . . . . . . . : 5554 HARVARD DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 286.-,9990
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 339 . 00 0 . 00 339 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 704 . 10 #3596
---------------
TOTAL RECEIPT 704 . 10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
t
cvyo (., ol (o -7
CITY.OF. CUPERTINO:.
r
REROOF
�CUPER,TiNO PERMIT APPLICATION
•A # Date:
&9 � o�?. � a3 ��
Building Address:
aoo3 0
Owner's Name:
Phone #:
(off �(-
Contractor: Phone #:
�o07-C�;, 7G(a — Sc�92�
Fax #: (� o�O —� /
Cupertino Business icenge #: Contractor License #:
<s-8
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Ropf _ ❑ Built-Up roof
�_❑ Asphalt Shingles �F:sphalt Shingles
y� Wood Shakes ❑ Wood Shakes
0 Wood Shingles ❑ 'Wood Shingles
1 ❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings O ProvideI.C.B.O.Report #
IC-To be Removed ❑ Provide Mf&.Installation.Specs.
Job Description: r2 fj�0 ur/1� e�s
li'r $fz'jlrny 30 # )Se 4- dta Sgc.,re$ 04 C-
0
— r��J
10
Residentia Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: 15
Valuation: � 0j 000
I Have Read, Understand and Will Comply with Cupertino's Tear-OdPolicy:
r _ .
Si � a re
1
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and%or tear off approval.
2) In-progress inspection approval.
3) 'Final inspection approval.
a) Spark arrester installation.
1 5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 9eLl-Gj U TP�GJ� —
Job Site Address: Q d:?s CD (�D e, PCCJ MC(_,
R oofing Company Name: LloLCt `R604;nG- CQ,
Applicant's Signature: _,^_ Cr Date: �lp�
' Greg Casteel
Building Official
Revised 11/2/04
Community Development
y 10300 Torre Avenue
F,t Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
JUPEkTINO
Building Department
JOB ADDRESS: 0030 D-e, ��C n. PERMIT #
6"
OWNER'S
OWNER'S NAME: 2 e We, PHONE #
GENERAL CONTRAC n pa n" FAX #
I am not using any subcontractors: —tom.) C�� (� 3 0a
3 U
SignatureD' ate
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
' Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
I
Owner/Contractor Signature Date